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3. Health Problems of Homeless People
Pages 39-75

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From page 39...
... The most common of these are the major mental illnesses, especially chronic schizophrenia. As mentally ill people's disabilities 39
From page 40...
... Samuel Anderson arrived in New York City in 1985 from his native Oklahoma. He is 24 years old, educated through the 11th grade, and says he left his rural surroundings because there was no opportunity to work, it.
From page 41...
... Other health problems that may result from or that are commonly associated with homelessness include malnutrition, parasitic infestations, dental and periodontal disease, degenerative joint diseases, venereal diseases, hepatic cirrhosis secondary to alcoholism, and infectious hepatitis related to intravenous (IV) drug abuse.
From page 42...
... In a homeless person, however, treatment is virtually impossible: Some types of insulin need to be refrigerated; syringes may be stolen (in cities where IV drug abuse is common, syringes have a high street value) or, sometimes, the homeless diabetic may be mistaken for an IV drug abuser; and diet cannot be controlled because soup kitchens serve whatever they can get?
From page 43...
... This group of tables is divided further by sex, ethnic group, and age (Tables 3-2, 3-4, and 3-61. The comparable prevalence rates for the domiciled general population are available from the National Ambulatory Medical Care Survey (NAMCS)
From page 44...
... In addition, primitive living conditions result in unusual risks; for example, the use of open fires for warmth predisposes them to potential burns. Most of the findings in the literature, including those from the national HCH program, describe inner city homeless people.
From page 45...
... , which is possibly related to inadequate opportunities to bathe or shower and which is associated with infestations TABLE 3-2 Rates of Occurrence (in percent) of Acute Physical Disorders, by Age, in the Johnson-Pew HCH Client Population Adults in the Following Age Groups Seen more than Once I II III IV NAMCS (N= (N= (N= (N= (N= Diagnosis 3,766)
From page 46...
... Moreover, homeless people do have an increased frequency of bacterial cellulitis and other pustular skin lesions. Finally, homeless people are at high risk of developing subcu
From page 47...
... of Chronic Physical Disorders, by Age, in the Johnson-Pew HCH Client Population Adults in the Following Age Groups Seen more than Once I II III IV NAMCS (N= (N= (N= (N= (N= Diagnosis 3,766)
From page 48...
... Forty-four required either prophylaxis or treatment according to recommendations of the American Thoracic Society. Compared with nonhomeless populations, these homeless individuals had a very high frequency of skin test reactivity and positive cultures.
From page 49...
... of Infectious and Communicable Disorders, by Age, in the Johnson-Pew Health Care for the Homeless Client Population Adults in the Following Age Groups Seen more than Once: I II III IV NAMCS (N= (N= (I= (N= (N= Diagnosis 3,766)
From page 50...
... MENTAL ILLNESS, ALCOHOLISM, DRUG ABUSE, AND COMORBIDITY OF HOMELESS ADULTS Mental Disorders Many homeless adults suffer from chronic and severe mental illness. The visibility of mentally ill people has led to the creation of a stereotype for the entire homeless population; the earlier stereotype of the homeless alcoholic has been replaced in recent years with that of the mentally ill homeless person (Stark, 1985, 19874.
From page 51...
... , are of limited value in defining the prevalence of psychiatric disorders or in predicting needs for mental health services. Estimates of the prevalence of current major mental illness range from 25 to 50 percent of individual homeless adults (Bachrach, 1984~.
From page 52...
... Detroit (Mowbray et al., 1985) 11.2 14.8 17 18 33.2 19 20 22 23 23 25 26 aBy point of contrast, a special analysis of preliminary data from four ECAs performed by the NIMH ECA program at the request of the Institute of Medicine showed that a range of from 3 to 6.6 percent of the general adult population acknowledged a history of psychiatric hospitalization (including alcohol and drug treatment facilities)
From page 53...
... mental disorders or substance abuse disorders. Of the total sample, 11.5 percent met the diagnostic criteria for schizophrenia, 20 percent met the criteria for major affective disorders, and 3 percent displayed severe cognitive impairment suggestive of dementia; 17 percent met the criteria for antisocial personality disorder, and 31 percent apparently abused alcohol or other drugs.
From page 54...
... 54 Cal o US o Cal Cal Ct it: o Cal ._ V)
From page 55...
... 55 -^ ~ o _ a: a.~ ~ 1 ~ ~ o ~ ~ _ At,= o = 00 '_ ~ Q ret - } ~ ~ O ~ Ct ~ ~ ~ s' Cry ~ ~ ~ ~ 1 ~ ~ ~ ~ ~ ~ 1 ~ o 't use ~ _ so C~ O ° v ~ 3 ° Ct ~ -= t~ ~ to Ct o o ~ 5 · ~ Z O _ I_ ·= ~ Cal ~= ~ .^ i= ~ V)
From page 56...
... mental or substance abuse disorder; 4 percent of the total sample suffered from major mental illnesses, and 20 percent suffered from alcohol or drug abuse problems. Using virtually identical standardized diagnostic procedures but very different sample populations these two 1986 studies (Farr et al.
From page 57...
... In both groups mental disorders are found that can be considered both a cause and a consequence of homelessness. Clinical Problems in Providing Mental Health Care for the Homeless The central problem for homeless people with mental illnesses is the lack of community-based treatment facilities and adequate housing.
From page 58...
... A therapist may be frustrated by failures of homeless patients to keep appointments; and clinics may be unwelcoming to dirty, disheveled, or disorganized patients who frighten away others. The treatment and rehabilitation of a severely mentally ill homeless person requires the marshaling of major financial and professional resources.
From page 59...
... Mental health workers may believe that medication and supportive care could substantially help a mentally ill person cope, but the patient is legally entitled to refuse treatment. Mentally ill homeless people have attracted considerable attention from the news media.
From page 60...
... alarming numbers of families with young children; and (3) an increased proportion of people with mental illnesses and histories of drug abuse.
From page 61...
... 61 Do l Do ~4 o of a: o ¢ o o ¢ o au 5~ au ~ son c)
From page 62...
... . Wright and Weber (1987J have identified specific disorders that occur more frequently among homeless alcoholics than other homeless people; these include acute disorders, such as trauma, serious skin problems, and severe upper respiratory infections, along with chronic disorders such as cardiac disease, hypertension, and active tuberculosis.
From page 63...
... Most studies about the homeless combine alcohol and drug abuse together under the heading of substance abuse. Those that separate the two provide some minimal information about illicit drug use.
From page 64...
... The strongest correlate of drug abuse is age. As with the general domiciled population, rates of illicit drug abuse are highest among younger HCH clients and fall off with increasing age, especially after the age of 50.
From page 65...
... Using this series of multivariant analyses, which controlled statistically for age, sex, ethnicity, and family status and for alcohol abuse and mental illness, the following disorders were found more commonly among homeless people who were drug abusers: AIDS, liver disease, cardiac disease, peripheral venous stasis disease, and chronic disorders such as diabetes and diseases of the liver and genitourinary tract. Although the exact relationship between homelessness and drug abuse and these illnesses is unclear, most of the findings are not surprising.
From page 66...
... With regard to mental illness, although many homeless mothers have emotional problems, most do not suffer from a major mental illness (e.g., schizophrenia)
From page 67...
... reported that the rate of chronic physical disorders is nearly twice that observed among the children in the NAMCS population in general. Whether geographic mobility and residential instability will make these children a greater health risk to the general population is unknown, but it is a potential public health problem of concern.
From page 68...
... The leading example is major mental illness, especially schizophrenia, in the absence of treatment facilities and supportive housing arrangements. Second, the condition of homelessness and the exigencies of life of a homeless person may cause and exacerbate a wide range of health problems.
From page 69...
... The last (rightmost) columns of numbers in Tables 3-2, 3-4, and 3-6 show the data for adult respondents in urban areas from the National Ambulatory Medical Care Survey (NAMCS)
From page 70...
... ANYCHRO Any chronic physical disorder CANC Cancer, any site ENDO Endocrinological disorders (e.g., goiter, thyroid, pancreas disease) DIAB ANEMIA NEURO SEIZ EYE EAR HTN CVA GI TEETH LIVER GENURI Diabetes mellitus Anemia and related disorders of the blood Neurological disorders, not including seizures (e.g., Parkinson's disease, multiple sclerosis, migraine headaches, neuritis, neuropathies)
From page 71...
... Pp. 11-53 in The Homeless Mentally Ill, H
From page 72...
... 1986. A Study of Homelessness and Mental Illness in the Skid Row Area of Los Angeles.
From page 73...
... 1983. Down and out in the city: The homeless mentally ill.
From page 74...
... 1987. Progress Report on the Veterans Administration Program for Homeless Chronically Mentally Ill Veterans.
From page 75...
... 1985. Strangers in a strange land: The chronically mentally ill homeless.


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